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HomeMy WebLinkAboutCLE201300118 Legacy Document 2013-06-06• Application for Zoning Clearance '�- CLE # ©13 ji OFFICE U ONLY �-3 3 PLEASE REVIEW ALL 3 SHEETS Check# Date: - Receipt # Staff: PARCEL INFORMATION / Tax Map and Parcel: D %DOb - b O - O D - 6 ,3 $' OQ Existing Zoning `^ Parcel Owner: L PD , L LC Parcel Address: Z S're 0 1..) A 1H {City 6 i' , // Me- State // A ZipZ z 9 d (include suite or floor) PRIMARY CONTACT ' //,, �[J R Who should we call/write concerning this project? k1111 R %L Address • 3 b b j�Res�o !� U e-- City C� 'y State y Zip Z.Zfd Office Phone: (_) Cell # Q� - Z T LOFax # 7` I Z' TSE -mail �0 t•41 , � o W W 2 j I� APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business 6L /A L. C I e C 42 / • �. Business Name /Type: A C R 14—F Previous Business on this site (/ Describe the proposed business including use, number of employees, num er of shifts, available parking spaces, number of ' formation that C b N R �- c -�- d R ' S O F Fr -e a vehic es, and any addition al ou can provide: M ��Y1IG jeso 6e,41W1N9 :5eAces Mot)H9 AG2ors +IAC StlaiveT *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I o i or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accur 'e toAhe best of my know g . I have read! conditions of approval, and I understand them, and that I will abide by them. /�--/ Signature x l4 14/a, Printed APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes • Building Official Date (o Zoning Official Date i /� j Other Official /`' I Date 6' 3 tY� v County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 9724126 Revised 7/1/2011 Page 2 of 3 c P- o w�, yeee Intake to complete the following: YIN Is use ii L1 I, II or PDIP zoning? If so, give applicant a Certified Engineer eport (CER) packet. Y/ Will ere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private well o p ublic water? If private well, provide He cent form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic oijublic sewer/ YIN Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # ;7-0 / ? "13 "0' v Zoningr to complete the following: Reviewer to complete the following: Square footage of Use: / fi / N �� Cr. Permitted as: �,v,Q.i.,., ,r , O Under Section: Supplementary regulations section: Parking formula: % I I �iMdlorhO L Qe�r' Ve4 Ci Required spaces: YIN y Items to be verified in the field: Inspector : Date: Notes: Violations: Y/ Ifs , ist: Proffers: Y /(N If so, List: Vari ce: Y /(1 If so, ist: SP's: '0 /N If so, List: b7 —L4 b 14:,b Clearances: SDP's (v 9 Revised 7/1/2011 Page 3 of 3 I,u6,. LL• Lvvu i i ; )thivi I No, 3994 P, 2 I tiMl L , S r. Y/ 1 ,V I T-ro ti 1 V CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, Z 0 N VI i C t e A 2 ff N LO- [County application name and number] was provided tog D Fn , L L G" the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number U �DO b - 0 6 - O a - O 3S6 a by delivering a copy of the application in the manner identified below: ✓ Hand delivering a copy of the application to P L L �- [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date Mailing a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date to the following address: [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature of Applicant �//// 1,p m L - Q(,JAR Print Applicant Name 6- 8 / -Zo�3 Date